consequences of chronic cough Flashcards
What are the pulmonary consequences of chronic cough
Dynamic airway compression in asthma
- expiration is difficults
- so build up of air trapped in alveoli can lead to rupture of visceral pleura
- air enters the pleural cavity and cause a penumothroax
What is a small pneumothorax and what happens
- less than 2 cm
Air enters the pleural cavity from:
- Penetrating injury to parietal pleura
- Rupture of visceral pleura
The Transmural pressure gradient is lost and long recoils towards the lung root and small pneumothorax results
What is a large pneumonthorax and what happens
- More than 2cm (between pareital and visceral pleura)
can occur due to:
- Penetrating injury to parietal pleura
- Rupture of visceral pleura
How is Pneumothorax Diagnosed
- History
- Examination
- > Reduced breath sounds ipsilaterally
- > Reduced ipsilateral chest expansion
-> Hypersonnace on percussion
- Investigation
How to spot a pneumothrax on a CXR
- Abscent lung markings peripherally (opaque lines and blood vessels)
- Lung edge is visible
- tracheal shift
What is a Tension pneumothorax
- one way valve created which permits air entry into pleural cavit on inspiration but cannot exit on expiration
- Intra-pleural pressure is increased with each inspiration
- Collapse on lung towards its root
- Eventaully shift in mediastinal structures
What are 4 divisions of the mediastinum
- Superior - T4
- Inferior - divided into (T7)
- Anterior
- Middle
- Posteiror
What are the consequences of a mediastinal shift
- Tracheal deviation - unilateral pneumothorax
- Superior vena cava compression
- Reduced Venous return to the heart
- Low arterial blood pressure
- Hypoxia, chest pain and dyspnoea
What is the Managment of a large pneumothorax
- Needle aspiration - 2-3rd intercostal space midclavicular line
- Chest Drain
the 4th and 5th intercostal space in the midaxillary line - the safe Triangle
What is the Safe Triangle
- Anterior border of lassimus dorsi
- Posteiror border of pectoralis major
- axial line superior to the nipple
entry into the middle of intercostal spaces due to NVB bundle
Whay is the emergency managment of a Tension penumothroax
- level of rib 2 = sternal anlge
- Midclavicular line
- Guage cannula inserted into pleural cavity via the 2nd and 3rd intercostal spaces
Cannula passes through:
- superficial fascia
- Deep fascia
- 3 layers of intercostal muscles
- Parietal pleura
Other consequences of chronic cough = Herniae
Two factors lead to development
- Weakness of one structure - commonly part of body wall
- Increased pressure on one side of that part of the body wall - due to chronic cough
Herniaes occuring from weekness in one structure
Normal anatomical weakness
- Diaphragm - diaphragmatic herniae
- Umbillicus - umbilical hernia
- Inguinal canal - inguinal hernia
- femoral canal- femoral hernia
Congenital abnormalities
- congenital Diaphragmatic hernia
Surgical scars weakness
- incisional hernia
Where do Diaphragmatic Hernias Develop
- Aortic Hiatus - level of T12
- Normal anatomical weekness at attachments to the xiphoid process
- Inferior Vena Cava -IVC canal opening - T8
- Oesophageal Hiatus - T10
- Normal anatomical weekness posteiror attachments
What is a paraoesophageal Histus Hernia
- Herniated part of the stomach passes through the oesophageal hiatus to become parallel to the Oesophagus and the chest
- Pocket sticks out parallel to the oesophagus
What is the Sliding hiatus Hernia
- The herniated part of the stomach slides through the oesopaheal hiatus into the chest with the gastro-oesophageal junction
Where is the inguinal region
Between the anterior superior illiac spine and the pubic tubercle
What are the inguinal ligaments
- connective tissue ligaments
- attach between the anteiror superior illiac spine and the pubic symphysis
- Their medial halves form the floor of the inguinal canal
inferior borders of the external oblique aponeurosis
What are the inguinal canals
- 4 cm long passage ways through anterior abdominal wall in the inguinal regions
- medial half of the inguinal liganments
- Deep ring (entry)
- superficial ring (exit)
where is the deep ring of the inguinal canal located
- superior to the midpoint of the inguinal ligament
Where is the superficial ring of the inguinal canal located
- V- shaped defect in the external oblique aponeurosis
- lies superiolateral to the pubic sympysis
What are inguinal Herniae
- they form in the medial half of the inguinal region
form due to:
- Weekness in inguinal canal - the canal forms during development and allows passage of the testes in males and passage of round ligament of uterus in female
- increased intra-abdominal pressure- chronic cough, chronic constipation, lifting heavy wieghts and athletic effort
Layers of the anteriolateral abdominal wall
- skin
- superficial fascia
- Deep fascia
- inguinal ligament
- internal oblique
- Tranverse Abdominis
- Transverse fascia
- parietal peritoneum
- Visceral peritoneum
- Testicular vein
- Testicular artery
How do the testes develope
Trans-abdominal phase
- A band of connective tissue known as the gubernaculum connects testis to the scortum
- The Gubernaculum drags the testis into the deep inguinal ring
Trans-inguinal Phase
- Process vaginalis (outpouching of the pariental peritonuem)
- pushes its way through tissue of developing abdonimal wall
- follows the course of the Gubernaculum
What tissues form the abdomincal wall become part of the psermatic cord
- Transverse falis fascia
- internal obliue
- External oblique
Becomes:
- Internal spermatic fascia
- Cremasteric fascia
- External spermatic fascia
The distal tip of the process vaginalis becomes the tunica vaginalis
What are the complete contents of the spermatic cord
- Vas deferens
- testicualr artery
- paminiform plexus of veins
- automonic nerves
- genetofemoral nerve
- lymathetics
What does the illioinguinal nerve inervate
anteiror surface of scortum
branches from L1
the female inguinal canal
females also have inguinal regions, inguinal ligaments, inguinal canals, deep inguinal rings, superficial inguinal rings and can develop an inguinal hernia (less commonly)
How do ovaries develop
- in the abdominal wall
- Round ligaments passes through inguinal canal into the labium majus
- these are the fibrous embryological remenants in adult female
What is a direct inguinal herniea
a ‘finger’ of peritoneum is forced through posterior wall of the inguinal canal and directly out of the superficial ring into the scortum
What is an indirect herniea
a ‘finger’ of peritoneum is first forced through the deep ring into inguinal canal and then out of superficial ring into the scortum
How to clinically differentiate between a direct and indirect herniea
- Reduce hernia (200 feet up)
- Occulfe the deep ring with finger tip pressure
- ask patient to cough
If its direct - lump will appear
if its indirect - lump will not appear
